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The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

  • Andrea Iaboni
    Affiliations
    Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Department of Psychiatry and Geriatric Rehabilitation Program, University Health Network, Toronto, Ontario, Canada
    Search for articles by this author
  • Alastair J. Flint
    Correspondence
    Send correspondence and reprint requests to Alastair J. Flint, M.B., F.R.C.P.C., F.R.A.N.Z.C.P., Toronto General Hospital, 200 Elizabeth St., 8 Eaton North–Room 238, Toronto, ON M5G 2C4, Canada.
    Affiliations
    Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Department of Psychiatry and Geriatric Rehabilitation Program, University Health Network, Toronto, Ontario, Canada

    Toronto Rehab and Toronto General Research Institutes, Toronto, Ontario, Canada
    Search for articles by this author
Published:February 22, 2013DOI:https://doi.org/10.1016/j.jagp.2013.01.008
      Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive–behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture prevention guidelines.

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